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Impact of physical activity on CVD outweighs BMI?

By Maria Simonenko - EBTR Section

Sports Cardiology

The recently published new results of the Rotterdam Study are about the impact of physical activity (PA) on the association of overweight and obesity with cardiovascular disease (CVD). This study was a prospective population-based cohort study among people aged 55 years or older in the municipality of Rotterdam, The Netherlands.

Previous research has shown that PA may mitigate the association between overweight/obesity and a number of negative health outcomes; however, less is known on how the duration of overweight/obesity alters this association (1). Although overweight and obesity are associated with an increased risk of CVD (2-4), higher levels of PA are associated with a decreased risk of CVD (5-7). However, to what extent PA can counterbalance the risk associated with overweight and obesity remains unclear. Results of current study showed that among the participants with lower levels of PA, being overweight and obese was associated with a higher risk of CVD. Low PA levels increased the risk of CVD in the total population. These findings suggest that the impact of PA on CVD might outweigh that of BMI among middle-aged and elderly participants. The participants with low levels of physical activity were more often male, older and current smokers than the participants with a high level of physical activity.

A review combining studies that evaluated the risk associated with obesity and PA reported that four of eight studies favoured the hypothesis that the risk for cardiovascular mortality was lower in obese participants with high PA than in normal weight participants with low levels of PA (8).

Moreover, authors showed that the magnitude of the association between reduced PA and CVD was roughly similar to that between obesity and CVD, although the latter did not reach statistical significance. However, overweight and obese participants with high levels of PA were not at a significantly increased risk of CVD, whereas being overweight and obese was associated with an increased risk of CVD among physically inactive participants.

Their results, although not refuting the cardiovascular risk associated with overweight and obesity, suggest that the impact of PA on CVD might outweigh that of BMI among middle-aged and elderly adults.

Results of this study are based on self-reported PA. Although their questionnaire (Zutphen Physical Activity Questionnaire) has been shown to be both valid and reliable (9), potential recall bias and social desirability cannot be excluded. These last two limitations could have resulted in bias towards the null hypothesis. The negative point is there are no articles with results based on this questionnaire which can be compared with this study and similar population. Information on diet quality was not collected at the same time as BMI and PA what could turn into wrong evaluation.

The combination of two factors – obesity and no exercise – increased risk of CVD. PA, on the other side it has been associated with positive outcomes in obese patients. The results of this current article are interesting and it will be useful to evaluate other populations and turn it into a complex study.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology


Maria Simonenko commented on this article:

Impact of physical activity on the association of overweight and obesity with cardiovascular disease: The Rotterdam Study

Chantal M Koolhaas et al.

European Journal of Preventive Cardiology, doi: 10.1177/2047487317693952

additional references:

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2. Lavie CJ, Milani RV and Ventura HO. Obesity and car- diovascular disease: Risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009; 53: 1925–1932.
3. Calle EE, Thun MJ, Petrelli JM, et al. Body-mass index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341: 1097–1105.
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9. Westerterp K, Saris W, Bloemberg B, et al. Validation of the Zutphen physical activity questionnaire for the elderly with doubly labeled water [abstract]. Med Sci Sports Exerc 1992; 24: S68.